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NHC Advantage (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for NHC Advantage (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on NHC Advantage (HMO I-SNP) in 2026, please refer to our full plan details page.
NHC Advantage (HMO I-SNP) is a HMO I-SNP plan offered by Missouri Healthcare Advisors, LLC available for enrollment in 2025 to people living in MO-partial TN-partial SC-partial NC-partial. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that NHC Advantage (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
NHC Advantage (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about NHC Advantage (HMO I-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For NHC Advantage (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $8100.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The NHC Advantage (HMO I-SNP) Medicare Advantage plan features an annual prescription drug deductible of $615. You will need to pay this deductible amount out-of-pocket for your covered medications before the plan begins to cover its portion of your prescription costs. Specific drug coverage tier details, including individual copays and coinsurance rates, are not available for this plan. To understand your exact out-of-pocket costs for specific medications, we recommend reviewing the plan's comprehensive drug formulary.
Additional Benefits
The NHC Advantage (HMO I-SNP) plan offers comprehensive coverage with no copays for several essential services, including inpatient hospital stays, primary care visits, and home health care. For many outpatient services, diagnostic tests, and durable medical equipment, members will generally pay a 20% coinsurance and no copay. Emergency care is available with a $90 copay, while urgently needed services require a 20% coinsurance of up to $40 per visit with no copay. Additionally, the plan features valuable supplemental benefits like routine vision, dental, and hearing coverage, often featuring no copays and generous annual allowances. For instance, members receive up to a $2,000 annual limit for prescription hearing aids and up to $1,650 for select dental services with no copay or coinsurance. Other perks include a quarterly allowance of $165 for over-the-counter items and up to $1,300 annually for supplemental durable medical equipment.
Inpatient Hospital See details
NHC Advantage (HMO I-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization and Medicare-defined deductibles do apply. Additional hospital days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
NHC Advantage (HMO I-SNP) covers outpatient services, including ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with a 20% coinsurance and no copay. Outpatient hospital services require a 20% coinsurance, while outpatient observation services incur a $100 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered by NHC Advantage (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
NHC Advantage (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, and this coinsurance is not waived if you are admitted to the hospital. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
NHC Advantage (HMO I-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a 20% coinsurance (up to $40 per visit) and no copay, with both counting toward the plan deductible. These cost-sharing fees are waived if you are admitted to the hospital within 3 days, though worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
NHC Advantage (HMO I-SNP) offers primary care physician and opioid treatment services with no copay and no coinsurance. Other covered services, including specialist visits, mental health, and physical therapies, have no copay but require a 15% to 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by NHC Advantage (HMO I-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar services, kidney disease education, and select screenings. However, the benefit is only partially covered, as an annual physical exam and additional services like fitness benefits, health education, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by NHC Advantage (HMO I-SNP), featuring one routine hearing exam annually with no copay and 20% coinsurance, and prescription hearing aids with no copay or coinsurance up to a $2,000 yearly limit. However, this benefit is partially covered because fitting and evaluation services, OTC hearing aids, and inner ear, outer ear, and over-the-ear prescription hearing aid types are not covered.
Vision Services See details
NHC Advantage (HMO I-SNP) covers vision services with no deductibles, including eye exams with no copay and a 20% coinsurance for routine visits. Eyewear, including contacts, eyeglasses, frames, and upgrades, is covered with no copay and no coinsurance up to a $300 annual maximum benefit.
Dental Services See details
Dental Services are partially covered by NHC Advantage (HMO I-SNP), offering Medicare-covered dental services with no copay and a 20% coinsurance, and other dental services with no copay and no coinsurance up to a $1,650 annual maximum. While most preventive, diagnostic, and restorative treatments are covered, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by NHC Advantage (HMO I-SNP) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, range from no coinsurance to 20% coinsurance, with insulin services specifically requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by NHC Advantage (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
NHC Advantage (HMO I-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics or medical supplies.
Diagnostic and Radiological Services See details
NHC Advantage (HMO I-SNP) partially covers diagnostic and radiological services, requiring a 20% coinsurance and no copay for covered services, alongside prior authorization. Covered services include diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays, while lab services are not covered under this plan.
Home Health Services See details
Home Health Services are covered by NHC Advantage (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
NHC Advantage (HMO I-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, but in practice, only some services are covered. Specific sub-services, including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services, are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
NHC Advantage (HMO I-SNP) provides partially covered Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. Admission does not require a prior three-day inpatient hospital stay, but additional days beyond Medicare-covered days are not covered.
Other Services See details
NHC Advantage (HMO I-SNP) partially covers other services with no copay and no coinsurance, including up to $165 every three months for over-the-counter items and up to $1,300 annually for supplemental durable medical equipment. Acupuncture and meal benefits are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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